Soft Tissue [Guest Lecture] Flashcards
Describe the difference between a primary and secondary soft tissue injury
Primary: caused by self-infliction, another individual/entitiy, or the environment
Secondary: inflammatory response that results from the primary injury
List the 3 types of Primary Soft tissue injuries
- Acute
- Chronic
- Acute on Chronic
List 3 complications that can affect the healing cycle
- Infection
- Compromised circulation
- Neuropathy
Phase of Healing: Pain at rest, with motion, and with applied stress; 1-6 days
Inflammatory (Acute) Phase
If severe enough can result in mm guarding or loss of function
Phase of Healing: Capillary growth, granulation tissue formation, fibroblast proliferation with collagen synthesis and increased macrophage and mast cell activity; 5-15 days up to 10 weeks
Proliferative (Sub-Acute) Phase
The length of this phase is determined by the extent of the injury, the healing capacity of the pt., complications, etc.
Phase of Healing: Conversion of initial healing tissue to scar tissue; lasts up to a year
Remodeling (Chronic) Phase
Think pick up stick: The disorder of the cells in scar tissue can contribute to a raised appearance but can be reorganized with soft tissue work
List 4 reasons for soft tissue dysfunction
- Adaptive shortening: where scar tissue contracts when healing
- Loss of tissue extensibility
- Decrease gliding of adjacent tissue
- Adhesions (think sticky cobwebs under the skin)
Describe the effects of soft tissue dysfunction
Can lead to hypermobility, muscle imbalance, altered ROM, and neural tension
List the absolute contraindications to soft tissue mobilization
- Skin hypersensitivity
- Active malignancy
- Open wound
- Non-union fx
- Thrombophlebitis
List the precautions to soft tissue mobilization
- Acute RA/RA
- Anticoagulant therapy
- Mental disturbances
List the 6 Principles of Soft Tissue Tx
- Pt must be RELAXED
- Tell the pt. what to expect
- Use in combination for increased effectiveness
- Consider active participation from the pt.
- Compliment tx with HEP
- ASSESS AND REASSESS
Describe the guidelines for soft tissue mobilization in the acute stage
Use shortening/broadening techniques with active or passive pumping
Describe the guidelines for soft tissue mobilization in the subacute stage
use shortening/broadening techniques, beging lengthening just short of resistance, pumping with increased vigor
Describe the guidelines for soft tissue mobilization in the remodeling stage
use muscle stretching, increase mobility to full range
Describe Hoffa Massage
Light/superficial strokes performed in the direction of the mm fibers used to familiarize a pt. with the technique before moving to more vigorous soft tissue work
Goal: increase blood flow and relaxation
Decribe the 4 types of massage strokes
- Effleurage/stroking – superfiical
- Pettrisage/kneading – deep
- Percussion - good for loosening mucus
- Vibration – often used with percussion
Type of Soft Tissue Mobilization:
- Assess skin movement around a focal point
- Assess quality of movement and end feel
- Good at finding a site of adhesion with scarring
- Can lengthen or broaden
Skin Gliding
Type of Soft Tissue Mobilization:
- Uses 2-3 fingers or knuckles
- Increase mm/skin mobility
- Uses counterstain while stroking in the direction of restriction
- Is a form or myofascial stroking
J Stroke
Type of Soft Tissue Mobilization:
- Effective over bony prominences
- Moves tissue superior/inferior and medial/lateral
- Restricted areas look like an orange peel
- Lengthens and broadens
Skin Rolling
Type of Soft Tissue Mobilization:
- Can use thumb, finger, elbow, knuckle
- Performed on mm belly, where 2 mm meet
- Moderate/Deep pressure parallel to fibers
- Petrissage technique
- Lengthens and reduces tension
Longitudinal Stroking
Type of Soft Tissue Mobilization:
- Bring inflammation to area to promote healing/promote proper collagen formation
- Breaks down adhesion and decreases pain
- Movement is perpendicular, typically over tendons
- Broadens DOES NOT lengthen
Transverse Friction Massage or Cross Friction Massage
Type of Soft Tissue Mobilization:
- Evaluates mm mobility in relationship to surrounding structures
- Broadens and lengthens
Muscle Bending
Type of Soft Tissue Mobilization:
- Tx a hyperactive spot within a taut mm/fascia by providing ischemic pressure to release mm spasm
- Reproduces pain
Trigger Point Release
Goal is to releax/release twitch, increase blood flow, and stretch
Held for 1-5 min/point
Type of Soft Tissue Mobilization:
- Tx areas of tethered tissue that result in adaptive shortening and mm weakness
- Decreases fascial restriction and improves healing (including emotionally)
Myofascial Release
Type of Soft Tissue Mobilization:
- Series of pulses that ebb and flow
- Imbalance in pulses leads to dysfunction
- Fluctuations are caused by changes in CSF flow/pressure
- Uses rhytmic oscillation to promote relaxation
Craniosacral Therapy
Type of Soft Tissue Mobilization:
- Uses diagonal patters with rotational components
- Stronger mm facilitate weaker mm
- Can be used isometrically or throughout range
Proprioceptive Neuromuscular Facilitation (PNF)
Type of Movement Therapy:
- Movement abnormalities develop with age, trauma, and posture
- Guided movement can break habitual patterns and move the pt. to a pain free position
- Uses circular movements
Feldenkrais
Type of Movement Therapy:
- Improve posture and body mechanics through conscious learning
- 3 steps: awareness, inhibition, conscious control of habit (integrating a new functional one)
Alexander
Type of Soft Tissue Mobilization:
- Indirect
- Good for acute/irritable
- Move to position of comfort or slack and hold for long duration
Strain-counterstrain
Type of Soft Tissue Mobilization: Based on strain-counterstrain, but positional release utilizes a facilitating force/compression to enhance the effect of the position
Positional Release
Type of Soft Tissue Mobilization: PT applies over adhesions in the tissue and the pt. is asked to actively move the body part to elongate the mm from a shortened position
Active Release Technique
